Small pharmacies struggling to obtain reimbursement for COVID-19 vaccine administration

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Many community pharmacies are finding it difficult to get reimbursement for the COVID-19 vaccines they administer, according to a Feb. 12 report from NBC News.

Pharmacists who work at small, independent pharmacies told NBC News it is hard for them to bill insurance companies for COVID-19 vaccine administration because health plans bar pharmacists from seeking reimbursement outside of pharmacy benefits, and vaccine administration falls under the category of medical benefits.

"It's a legacy problem," Antonio Ciaccia, a senior adviser to the American Pharmacists Association, told NBC News. "We don't really have a seamless integration of pharmacy services into traditional care benefit plans, and we have yet to see any guidance from a number of the plans outside of the Medicaid sector in terms of how they're going to handle this."

For administering two shots of a COVID-19 vaccine, most pharmacies expect to receive between $30 and $40 from insurance companies. Pharmacists told NBC News billing vaccine administration to various health plans means they have to take on the time-consuming task of navigating different insurance companies' bureaucratic processes, which vary greatly, during a time when they are already overwhelmed.

"At times, we just eat those claims,” Abby Rice, who owns two community pharmacies in Kansas, told NBC News. "Let's be honest here, the work on the back end, as far as the time you put in for the reimbursements, it’s a lot for very little."

More articles on pharmacy:
FDA says Moderna can increase COVID-19 vaccine volume per vial by 40%
US buys 200M more COVID-19 vaccine doses
Fresenius Kabi pays $50M for destroying records ahead of FDA probe

 

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